Effect of losartan on microalbuminuria in normotensive patients with type 2 diabetes mellitus: a randomized clinical trial

Article Abstract:

Background: Angiotensin-converting enzyme inhibitors have shown antiproteinuric effects in normotensive and hypertensive diabetic patients. Angiotensin-receptor antagonists reduce urinary albumin excretion and the risk for renal and cardiovascular complications in hypertensive patients with type 2 diabetes mellitus. The effect of angiotensin-receptor antagonists in normotensive diabetic patients with microalbuminuria has not yet been reported. Objective: To assess the antiproteinuric effects of losartan in normotensive patients with type 2 diabetes and microalbuminuria. Design: Multicenter randomized, double-blind, placebo-controlled clinical trial. Setting: 19 outpatient clinics in the Netherlands. Patients: 147 normotensive patients with type 2 diabetes mellitus and microalbuminuria. Intervention: 74 patients were randomly assigned to receive assigned to receive losartan and 73 patients were assigned to receive placebo for 10 weeks; 71 patients in each group completed the study. The losartan dose was 50 mg during the first 5 weeks and 100 mg during the subsequent 5 weeks. Measurements: Change in urinary albumin excretion rate after 5 and 10 weeks, change in creatinine clearance and blood pressure, and safety and tolerability of losartan. Results: A significant 25% relative reduction in the albumin excretion rate occurred after 5 weeks of the 50-mg losartan dose, with further improvement over the subsequent 5 weeks with the 100-mg dose (relative reduction, 34%). In the losartan group, creatinine clearance did not improve and blood pressure decreased slightly. Side effects did not differ between treatment groups. Conclusions: The angiotensin-receptor antagonist losartan reduces urinary albumin excretion in normotensive patients with type 2 diabetes and microalbuminuria. In multivariate analysis, the antiproteinuric effect of losartan was independent of the associated reduction in blood pressure. Losartan was safe and well tolerated in these normotensive patients.

Evaluation, Prevention, Type 2 diabetes, Diabetic nephropathies, Losartan, Author Abstract

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Continuous dexamethasone infusion for seven hours in patients with the Cushing syndrome: a superior differential diagnostic test

Article Abstract:

Cushing syndrome is caused by abnormally high amounts of hormones released from the adrenal cortex, resulting in excessive levels of glucocorticoids. Symptoms of Cushing's syndrome include protein loss, excessive fat in the body, fatigue and weakness, bone loss, lack of menstruation or impotence, weak capillaries (small blood vessels), fluid accumulation, excess hair growth, diabetes, and abnormal skin changes. The effectiveness of the intravenous dexamethasone suppression test in diagnosing patients with Cushing syndrome was assessed in 101 patients with the syndrome. A dose of one milligram (mg) per hour of dexamethasone was infused directly into the circulation for seven hours. A decrease in the level of cortisol indicated a positive test for Cushing syndrome. The syndrome was attributed to corticotropin (ACTH)-secreting pituitary tumors in 90 cases, adrenal adenoma in 13 cases, adrenal carcinoma in nine cases, other ACTH-secreting tumors in six cases, corticotropin-releasing hormone (CRH)-secreting tumors in two cases, and adrenal hyperplasia (cell overgrowth) in one case. The intravenous dexamethasone suppression test was 100 percent sensitive, 90 percent specific, and 98 percent accurate in identifying patients with ACTH-secreting pituitary adenomas, but produced false test results in both patients with CRH-secreting tumors. The continuous intravenous dexamethasone suppression test is an effective and convenient test for diagnosing Cushing syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Dexamethasone, Adrenal gland diseases

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Rapid reversal of acute psychosis in the Cushing syndrome with the cortisol-receptor antagonist mifepristone (RU 486)

Article Abstract:

Mifepristone (RU 486), referred to by some as the 'abortion pill,' is known to be a progesterone-receptor antagonist. Recent studies have reported that this drug may also be useful in reversing some of the clinical and biochemical abnormalities caused by excess secretion of cortisol (Cushing syndrome). Among the symptoms of abnormally high levels of cortisol is psychosis. Two case histories are presented of patients with inoperable adrenal tumors that were secreting high levels of cortisol. Both patients, who had acute psychotic symptoms, were treated with RU 486. A complete resolution of their psychotic symptoms within 24 to 72 hours was observed. No psychiatric symptoms recurred, and other symptoms of Cushing syndrome were also abating in the two patients when they died of their tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Progesterone, Mifepristone, Psychoses, Psychotic disorders, Progesterone receptors

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